How To Get Rid Of Polio For Good? There's A $5 Billion Plan

A child is immunized against polio at the health clinic in a farming village in northern Nigeria. The procedure involves pinching two drops of the vaccine into the child's mouth. For full protection, the child needs three doses, spaced out over time.

A child crosses a bridge over the cement-lined Gogo stream, which flows behind the main market in Kano, Nigeria. Sanitation workers regularly test the sewage here for the presence of the polio virus.

David Gilkey
/ NPR

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Originally published on April 2, 2013 8:56 pm

Polio is on the verge of being eliminated. Last year there were just over 200 cases of polio, and they occurred in just two remote parts of the world — northern Nigeria and the rugged Afghan-Pakistan border region.

A new $5.5 billion plan being pushed by the World Health Organization strives to eliminate polio entirely, phase out vaccination campaigns and secure polio vaccine stockpiles in case the virus somehow manages to re-emerge.

If the effort is successful, polio would be just the second disease in human history, after smallpox, to be eliminated by medical science.

"We've never been so close to eradication as we are now," says Hamid Jafari, the director of Global Polio Eradication at WHO.

A quarter of a century ago there were roughly 300,000 polio cases a year worldwide. By 2011 that number had dropped to 650, and last year it was down to 223.

The new Global Polio Eradication and Endgame Strategic Plan aims to bring the number of new wild polio cases down to zero by 2015 and eradicate the virus entirely by 2018. It targets "wild" polio from normal transmission and the handful of so-called "vaccine-derived" cases, which are caused by the vaccine.

The plan calls for an orchestrated global transition from the oral vaccine, which contains live polio virus (and thus can cause "vaccine-derived" polio paralysis), to an injected vaccine made from dead virus.

Jafari says previous attempts to wipe out polio have stumbled because they lacked global coordination or adequate funding. And the biggest risk to the new plan's success is "if it is not financed up front."

In the 1950s, polio was spread all around the globe. Terrified parents in the U.S. wouldn't allow their children to go swimming in late summer out of fear that they'd catch the incurable condition. Slowly polio has been eliminated from one part of the world after another. Now it continues to spread only in isolated parts of Nigeria, Afghanistan and Pakistan.

The WHO, UNICEF and the Bill & Melinda Gates Foundation, among others, have been pouring resources in to attack polio in these three countries.

Even though polio appears to be backed into a corner, Jafari says, it still has the potential to spread.

"Even as recently as 2011 we had an outbreak in China as a result as importation from Pakistan that killed many adults," he says. "Earlier this year the sewage sampling in Cairo detected wild polio virus that originated in parts of Pakistan."

The areas of Pakistan, Afghanistan and Nigeria where polio remains a problem are also areas torn by violence.

Apoorva Mallya, who works on vaccine-delivery programs for the Gates Foundation, says these incidents are unfortunate, but he points out that polio has been eliminated in other places during times of conflict.

"In specific places like Somalia, Sudan, El Salvador — it was during active conflict polio was stopped in those countries," he notes.

Mallya says what's really impressive is that India hasn't reported a new case of wild polio in more than two years. He says the new strategic plan incorporates many of the techniques and tools that were used in India to finish off the virus.

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Polio is on the verge of being wiped off the face of the earth. The count last year just 223 cases around the world and all of those occurred in just three countries. The World Health Organization is pushing an ambitious new plan to stop global polio transmission over the next two years and to eradicate the virus by 2018.

If the effort is successful, NPR's Jason Beaubien reports, polio would be just the second disease in human history, after smallpox, to be eliminated by medical science.

JASON BEAUBIEN, BYLINE: Polio eradication efforts have been going on for decades, but global health officials say never before have they been this close to stomping out the potentially devastating virus.

HAMID JAFARI: 2012 was a year where the lowest number of polio cases were reported in the world in the fewest districts around the world.

BEAUBIEN: Dr. Hamid Jafari is the director of Global Polio Eradication at the World Health Organization in Geneva. As part of what's called the Global Polio Eradication Initiative, Dr. Jafari has just unveiled a new plan to wipe out polio over the next six years. The $5.5 billion program aims to stop polio transmission, phase out vaccination campaigns and finally secure polio vaccine stockpiles in case the virus somehow manages to reemerge.

JAFARI: This plan is a comprehensive closeout plan for polio eradication. And the most important risk for this plan is that if it is not financed upfront.

BEAUBIEN: He says previous attempts to wipe out polio have stumbled because they lacked global coordination or adequate funding. The polio vaccine is very simple to administer. A few drops into a child's mouth can protect him or her from the potentially devastating paralysis. In the 1950s, polio was spread all around the globe. Terrified parents in the United States wouldn't allow their children to go swimming in the late summer out of fear that they'd catch the incurable condition.

Slowly, polio has been eliminated from one part of the world after another. Now, it only continues to spread in isolated parts of Nigeria, Afghanistan and Pakistan. The WHO, UNICEF and the Bill and Melinda Gates Foundation, among others, have been pouring resources into attacking polio in these three countries. Even though polio appears to be backed into a corner, Jafari says it still has the potential to spread.

JAFARI: Even as recently as 2011, we had an outbreak in China as a result of importation from Pakistan that killed many adults and that outbreak earlier this year, the Suez sampling in Cairo detected a polio virus that originated in parts of Pakistan.

BEAUBIEN: The parts of Pakistan, Afghanistan and Nigeria where polio remains a problem are also areas torn by violence. As recently as February of this year, nine female polio workers were gunned down in the northern Nigerian city of Kano. Apoorva Mallya, who works on vaccine delivery programs for the Bill and Melinda Gates Foundation, says these incidents are unfortunate, but he points out that polio has been eliminated in other places during times of conflict.

APOORVA MALLYA: There are specific places like Somalia, Sudan, El Salvador, it's during active conflict, polio was stopped in those countries.

BEAUBIEN: He says what's really impressive is that India hasn't reported a new case of wild polio in more than two years. Mallya says the final polio endgame plan incorporates many of the techniques and tools that were used in India to finish off the virus. Jason Beaubien, NPR News, Washington. Transcript provided by NPR, Copyright NPR.